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Refugia JM, Thakker PU, O'Rourke TK, Cohen A, Bradshaw A, Casals R, Sandberg M, Whitman W, Saini S, Hemal AK. Adoption of robot-assisted radical nephroureterectomy permits a minimally invasive option for management of upper tract urothelial carcinoma in geriatric patients: comparison with non-geriatric patients with intermediate-term oncologic follow-up. J Robot Surg 2024; 18:257. [PMID: 38896165 PMCID: PMC11186893 DOI: 10.1007/s11701-024-02013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
To assess the oncologic efficacy and safety of robot-assisted approach to radical nephroureterectomy (RARNU) in geriatric versus younger patients with upper tract urothelial carcinoma (UTUC). A single-center, retrospective cohort study was conducted from 2009 to 2022 of 145 patients (two cohorts: < 75 and ≥ 75 years old) with non-metastatic UTUC who underwent RARNU. Primary endpoint was UTUC-related recurrence of disease during surveillance (bladder-specific and metastatic). Safety was assessed according to 30-day, modified Clavien-Dindo (CD) classifications (Major: C.D. III-V). Survival estimates were performed using Kaplan-Meier method. There were 89 patients < 75 years (median 65 years) and 56 patients ≥ 75 years (median 81 years). Comparing the young versus geriatric cohorts: median follow-up 38 vs 24 months (p = 0.03, respectively) with similar 3-year bladder-specific recurrence survival (60% vs 67%, HR 0.70, 95% CI [0.35, 1.40], p = 0.31) and metastasis-free survival (79% vs 70%, HR 0.71, 95% CI [0.30, 1.70], p = 0.44). Expectedly, the younger cohort had a significant deviation in overall survival compared to the geriatric cohort at 1-year (89% vs 76%) and 3-years (72% vs 41%; HR 3.29, 95% CI [1.88, 5.78], p < 0.01). The 30-day major (1% vs 0) and minor complications (8% vs 14%, p = 0.87). Limitations include retrospective study design of a high-volume, single-surgeon experience. Compared to younger patients with UTUC, geriatric patients undergoing RARNU have similar oncologic outcomes at intermediate-term follow-up with no increased risk of 30-day perioperative complications. Thus, age alone should not be used to disqualify patients from definitive surgical management of UTUC with RARNU.
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Affiliation(s)
- Justin M Refugia
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA.
| | - Parth U Thakker
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Timothy K O'Rourke
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Adam Cohen
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Aaron Bradshaw
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Randy Casals
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Maxwell Sandberg
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Wyatt Whitman
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Sumit Saini
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Ashok K Hemal
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
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2
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Ye J, Zhang M, Bao Y. Discordance in HER2 expression in primary and recurrent/metastatic lesions of upper tract urothelial carcinoma. Asian J Surg 2024:S1015-9584(24)00843-1. [PMID: 38744655 DOI: 10.1016/j.asjsur.2024.04.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Jianjun Ye
- Department of Urology and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengni Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yige Bao
- Department of Urology and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
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Hirata H, Hoshii Y, Ito H, Tsuzuki T, Shiraishi K. Efficacy of Enfortumab Vedotin After Chemotherapy With Anti-programmed Death-Ligand 1 (PD-L1) Maintenance Treatment in a Clear Cell Variant of Invasive Urothelial Carcinoma of the Renal Pelvis: A Case Report. Cureus 2024; 16:e55766. [PMID: 38590488 PMCID: PMC11000029 DOI: 10.7759/cureus.55766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Among upper urinary tract urothelial carcinoma (UUTUC) cases, there are few reports of the clear cell variant. Systemic chemotherapy will be given according to the usual treatment for urothelial cancer unless lymph nodes or organ metastases make surgical treatment inappropriate. Here, we report a clear cell variant of UUTUC of the left renal pelvis with aortic lymph node metastasis. The patient in this case was treated with systemic chemotherapy, anti-programmed death-ligand 1 (PD-L1) maintenance treatment, radiation therapy, and enfortumab vedotin (EV) therapy. To determine which of the treatments contributed to the therapeutic effect, immunostaining was used. The results indicated that Nectin-4 was expressed in clear cell variant tissues, while programmed cell death protein 1 (PD-1) and PD-L1 expression levels were weak in these tissues. The patient maintained complete remission with these treatments. Two years after the initial treatment, the patient was still alive with no progression or metastasis.
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Affiliation(s)
- Hiroshi Hirata
- Department of Urology, Yamaguchi University, Yamaguchi, JPN
- Department of Urology, Graduate School of Medicine, Ube, JPN
| | - Yoshinobu Hoshii
- Department of Diagnostic Pathology, Yamaguchi University Hospital, Ube, JPN
| | - Hideaki Ito
- Department of Urology, Yamaguchi University, Yamaguchi, JPN
- Department of Urology, Graduate School of Medicine, Ube, JPN
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, Nagakute, JPN
| | - Koji Shiraishi
- Department of Urology, Yamaguchi University, Yamaguchi, JPN
- Department of Urology, Graduate School of Medicine, Ube, JPN
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4
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Huelster HL, Gould B, Schiftan EA, Camperlengo L, Davaro F, Rose KM, Soupir AC, Jia S, Zheng T, Sexton WJ, Pow-Sang J, Spiess PE, Daniel Grass G, Wang L, Wang X, Vosoughi A, Necchi A, Meeks JJ, Faltas BM, Du P, Li R. Novel Use of Circulating Tumor DNA to Identify Muscle-invasive and Non-organ-confined Upper Tract Urothelial Carcinoma. Eur Urol 2024; 85:283-292. [PMID: 37802683 DOI: 10.1016/j.eururo.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/28/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Optimal patient selection for neoadjuvant chemotherapy prior to surgical extirpation is limited by the inaccuracy of contemporary clinical staging methods in high-risk upper tract urothelial carcinoma (UTUC). OBJECTIVE To investigate whether the detection of plasma circulating tumor DNA (ctDNA) can predict muscle-invasive (MI) and non-organ-confined (NOC) UTUC. DESIGN, SETTING, AND PARTICIPANTS Plasma cell-free DNA was prospectively collected from chemotherapy-naïve, high-risk UTUC patients undergoing surgical extirpation and sequenced using a 152-gene panel and low-pass whole-genome sequencing. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To test for concordance, whole-exome sequencing was performed on matching tumor samples. The performance of ctDNA for predicting MI/NOC UTUC was summarized using the area under a receiver-operating curve, and a variant count threshold for predicting MI/NOC disease was determined by maximizing Youden's J statistic. Kaplan-Meier methods estimated survival, and Mantel-Cox log-rank testing assessed the association between preoperative ctDNA positivity and clinical outcomes. RESULTS AND LIMITATIONS Of 30 patients enrolled prospectively, 14 were found to have MI/NOC UTUC. At least one ctDNA variant was detected from 21/30 (70%) patients, with 52% concordance with matching tumor samples. Detection of at least two panel-based molecular alterations yielded 71% sensitivity at 94% specificity to predict MI/NOC UTUC. Imposing this threshold in combination with a plasma copy number burden score of >6.5 increased sensitivity to 79% at 94% specificity. Furthermore, the presence of ctDNA was strongly prognostic for progression-free survival (PFS; 1-yr PFS 69% vs 100%, p < 0.001) and cancer-specific survival (CSS; 1-yr CSS 56% vs 100%, p = 0.016). CONCLUSIONS The detection of plasma ctDNA prior to extirpative surgery was highly predictive of MI/NOC UTUC and strongly prognostic of PFS and CSS. Preoperative ctDNA demonstrates promise as a biomarker for selecting patients to undergo neoadjuvant chemotherapy prior to nephroureterectomy. PATIENT SUMMARY Here, we show that DNA from upper tract urothelial tumors can be detected in the blood prior to surgical removal of the kidney or ureter. This circulating tumor DNA can be used to predict that upper tract urothelial carcinoma is invasive into the muscular lining of the urinary tract and may help identify those patients who could benefit from chemotherapy prior to surgery.
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Affiliation(s)
- Heather L Huelster
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Elizabeth A Schiftan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lucia Camperlengo
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Facundo Davaro
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kyle M Rose
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Alex C Soupir
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julio Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Liang Wang
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Aram Vosoughi
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrea Necchi
- Department of GU Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Joshua J Meeks
- Departments of Urology and Biochemistry, Northwestern University, Chicago, IL, USA
| | - Bishoy M Faltas
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pan Du
- Predicine Inc., Hayward, CA, USA
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Joyce DD, Shan Y, Stewart CA, Chamie K, Galsky MD, Boorjian SA, Williams SB, Sharma V. A SEER-Medicare Based Quality Score for Patients With Metastatic Upper Tract Urothelial Carcinoma. Clin Genitourin Cancer 2024; 22:14-22. [PMID: 37537088 DOI: 10.1016/j.clgc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Population-based studies evaluating outcomes for metastatic upper tract urothelial carcinoma (mUTUC) are sparse and rarely capture both patients with de novo (synchronous) metastases and those who progress to metastatic disease (metachronous). Herein we evaluated the outcomes and costs associated with synchronous and metachronous mUTUC, utilizing a novel Methodology. Additionally, we created a guideline-based quality score to improve care in this space. PATIENTS AND METHODS We identified all patients with mUTUC aged 66 years and older included in the SEER-Medicare linked database between 2004 and 2012. Achievement of 3 quality criteria was assessed: (1) cancer-specific survival (CSS)>12 months; (2) receipt of systemic therapy; (3) receipt of hospice/palliative care. Total healthcare and out-of-pocket costs were evaluated. Regression analyses were performed to assess characteristics associated with quality criteria and total healthcare costs. RESULTS Of the 1223 patients identified, at least one quality criterion was met in just 40.2% and only 54 patients (4.4%) received palliative care. In multivariable analysis, patients with synchronous mUTUC (OR:0.55, 95%CI:0.41-0.72), and at least 3 comorbidities (OR:0.68, 95%CI:0.47-0.98) were less likely to achieve at least 1 quality criterion. Meeting at least 1 quality criterion was associated with increased costs ($94,677, 95%CI:87,702-101,652 versus $63,575, 95%CI:59,598-67,552). CONCLUSIONS Less than half of patients with mUTUC met at least 1 quality criterion. Quality score achievement was associated with a modest increase in total healthcare spending. These findings not only provide guidance for future study of rare diseases using secondary data, but also highlight inadequacies in the current management of mUTUC.
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Affiliation(s)
| | - Yong Shan
- Division of Urology, The University of Texas Medical Branch, Galveston, TX; Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Courtney A Stewart
- Division of Urology, The University of Texas Medical Branch, Galveston, TX
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX; Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN.
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6
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Gwak CH, Suh J, Lim B, Song C, You D, Jeong IG, Hong JH, Hong B, Ahn H. Preoperative C-reactive protein to albumin ratio as a novel prognostic biomarker for the oncological outcomes of radical nephroureterectomy. Urol Oncol 2024; 42:30.e17-30.e23. [PMID: 38072737 DOI: 10.1016/j.urolonc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/19/2023] [Accepted: 10/23/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE This study aimed to evaluate the prognostic impact of the preoperative C-reactive protein to albumin ratio (CAR) on progression-free survival (PFS) and cancer-specific survival (CSS) in patients with upper urinary tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). METHODS A retrospective analysis was conducted using data from a single-center nephroureterectomy registry between January 2011 and December 2017. Participants were categorized into high and low CAR groups based on the optimal CAR cut-off value determined using the Youden index. The primary endpoint was PFS, the time from RNU to metastasis or disease recurrence. The secondary endpoint was CSS, the time from RNU to UTUC-related death. Median PFS and CSS were compared between the high and low CAR groups using Kaplan-Meier analysis and log-rank test. Multivariable Cox proportional hazard regression analysis was performed to assess the prognostic significance of CAR, adjusting for known prognostic factors. RESULTS We included 491 patients with UTUC in the analysis. The optimal CAR cut-off value was determined to be 0.036, which resulted in classifying 49.3% (242/491) of patients into the high CAR group. The high CAR group had older patients (69.8 vs. 67.4, p-value = 0.01), advanced T and N stages (p-value<0.001), high-grade tumor (p-value = 0.03), and a higher incidence of preoperative hydronephrosis (p-value < 0.01) than the low CAR group. The high CAR group demonstrated significantly inferior median PFS (78.3 vs. 100.3 months, p-value < 0.01) and CSS (73.2 vs. 96.1 months, p-value < 0.01) than the low CAR group. Moreover, high CAR independently increased the risk of disease progression (hazard ratio [HR]: 1.80, 95% confidence interval [CI]: 1.23-2.64, p < 0.01) and UTUC-related mortality (HR: 1.79, 95% CI: 1.15, p < 0.01). CONCLUSION Pre-operative CAR is independently associated with poor PFS and CSS in patients with UTUC undergoing RNU. Moreover, CAR may be an independent UTUC prognostic factor, offering a cost-effective and minimally invasive marker. However, further validation through large-scale, multi-center studies is necessary to confirm these findings and determine the optimal CAR cut-off value.
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Affiliation(s)
- Chan Hoon Gwak
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea.
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
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Liedberg F, Hagberg O, Aljabery F, Gårdmark T, Jahnson S, Jerlström T, Ströck V, Söderkvist K, Ullén A, Bobjer J. Diagnostic pathways and treatment strategies in upper tract urothelial carcinoma in Sweden between 2015 and 2021: a population-based survey. Scand J Urol 2024; 59:19-25. [PMID: 38226846 DOI: 10.2340/sju.v59.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/20/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To report national data on diagnostics and treatment of upper tract urothelial carcinoma (UTUC) from the Swedish National Registry of Urinary Bladder Cancer (SNRUBC). PATIENTS AND METHODS Data from 2015 to 2021 were retrieved, and descriptive analyses were performed regarding incidence, diagnostic modalities, preoperative tumor staging, quality indicators for treatment including the use of standardized care pathways (SCP) and multidisciplinary tumor boards (MDTB). Time trends were explored for the study period. RESULTS Registrations included 1,213 patients with renal pelvic cancer and 911 patients with ureteric cancer with a median age of 74 (interquartile range [IQR] 70-77) and 75 (IQR 71-78) years, respectively. Incidence rates of UTUC were stable, as were proportions of curative treatment intent. Median number of days from referral to treatment was 76 (IQR 57-99) and 90 (IQR 72-118) days, respectively, for tumors of the renal pelvis and ureter, which remained unchanged after introduction of SCP in 2016. Noticeable trends included stable use of kidney-sparing surgery and increased use of MDTB. For radical nephroureterectomy (RNU), robot-assisted technique usage increased even for non-organ-confined tumors (cT3-4) and in one out of three patients undergoing RNU a bladder cuff excision was not registered. CONCLUSIONS The population-based SNRUBC with high coverage contributes to the knowledge about UTUC with granular and generalizable data. The present study reveals a high proportion of patients not subjected to curatively intended treatment and suggests unmet needs to shorten lead times to treatment and use of bladder cuff excision when performing radical surgery for UTUC in Sweden.
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Affiliation(s)
- Fredrik Liedberg
- Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Staffan Jahnson
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Viveka Ströck
- Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Anders Ullén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology and Urology unit, Karolinska University Hospital, Stockholm, Sweden
| | - Johannes Bobjer
- Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
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Klemm J, Bekku K, Abufaraj M, Laukhtina E, Matsukawa A, Parizi MK, Karakiewicz PI, Shariat SF. Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease. Cancers (Basel) 2023; 16:44. [PMID: 38201472 PMCID: PMC10777993 DOI: 10.3390/cancers16010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.
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Affiliation(s)
- Jakob Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria; (K.B.); (M.A.); (E.L.); (A.M.); (M.K.P.); (S.F.S.)
| | - Kensuke Bekku
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria; (K.B.); (M.A.); (E.L.); (A.M.); (M.K.P.); (S.F.S.)
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria; (K.B.); (M.A.); (E.L.); (A.M.); (M.K.P.); (S.F.S.)
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman 11733, Jordan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria; (K.B.); (M.A.); (E.L.); (A.M.); (M.K.P.); (S.F.S.)
- Institute for Urology and Reproductive Health, Sechenov University, 119991 Moscow, Russia
| | - Akihiro Matsukawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria; (K.B.); (M.A.); (E.L.); (A.M.); (M.K.P.); (S.F.S.)
- Department of Urology, Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Mehdi Kardoust Parizi
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria; (K.B.); (M.A.); (E.L.); (A.M.); (M.K.P.); (S.F.S.)
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC H2X 3E4, Canada;
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria; (K.B.); (M.A.); (E.L.); (A.M.); (M.K.P.); (S.F.S.)
- Institute for Urology and Reproductive Health, Sechenov University, 119991 Moscow, Russia
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 11942, Jordan
- Karl Landsteiner Institute of Urology and Andrology, 1090 Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 252 50 Prague, Czech Republic
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9
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Hoeh B, Kosiba M, Wenzel M, Meister N, Preisser F, Shariat SF, Hohenhorst JL, Becker A, Mandel P, Banek S, Roos F, Karakiewicz PI, Chun FK, Kluth LA. Comparison of survival outcomes between laparoscopic versus open radical nephroureterectomy in upper tract urothelial cancer patients: Experiences of a tertiary care single center. Curr Urol 2023; 17:292-298. [PMID: 37994335 PMCID: PMC10662872 DOI: 10.1097/cu9.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/11/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Materials and methods We retrospectively identified patients treated for UTUC from 2010 to 2020 from our institutional database. Patients undergoing laparoscopic or open RNU with no suspicion of metastasis (cM0) were for the current study population. Patients with suspected metastases at diagnosis (cM1) or those undergoing other surgical treatments were excluded. Tabulation was performed according to the laparoscopic versus open surgical approach. Kaplan-Meier plots were used to test for differences in overall and recurrence-free survival with regard to the surgical approach. Furthermore, separate Kaplan-Meier plots were used to test the effect of preoperative ureterorenoscopy on overall and recurrence-free survival within the overall study cohort. Results Of the 59 patients who underwent nephroureterectomy, 29% (n = 17) underwent laparoscopic nephroureterectomy, whereas 71% (n = 42) underwent open nephroureterectomy. Patient and tumor characteristics were comparable between groups (p ≥ 0.2). The median overall survival was 93 and 73 months in the laparoscopic nephroureterectomy group compared to the open nephroureterectomy group (p = 0.5), respectively. The median recurrence-free survival did not differ between open and laparoscopic nephroureterectomies (73 months for both groups; p = 0.9). Furthermore, the median overall and recurrence-free survival rates did not differ between patients treated with and without preoperative ureterorenoscopy. Conclusions The results of this retrospective, single-center institution showed that overall and recurrence-free survival rates did not differ between patients with UTUC treated with laparoscopic and open RNU. Furthermore, preoperative ureterorenoscopy before RNU was not associated with higher overall or recurrence-free survival rates.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Marina Kosiba
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Nicola Meister
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute for Urology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Jan Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Severine Banek
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Frederik Roos
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Felix K.H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Luis A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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10
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Sydén F, Baard J, Bultitude M, Keeley FX, Rouprêt M, Thomas K, Axelsson TA, Jaremko G, Jung H, Malm C, Proietti S, Osther PJS, Brehmer M. Consultation on UTUC II Stockholm 2022: diagnostics, prognostication, and follow-up-where are we today? World J Urol 2023; 41:3395-3403. [PMID: 37540248 PMCID: PMC10693525 DOI: 10.1007/s00345-023-04530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE To summarise the current knowledge regarding diagnostics, prognostication and follow-up in upper tract urothelial carcinoma (UTUC). METHODS A scoping review combined with expert opinion was applied to provide an overview of the current research field. Based on the published literature and the experts' own experience and opinions, consensus was reached through presentations and discussions at the meeting Consultation on UTUC II in Stockholm 2022. RESULTS The strongest prognostic factors in UTUC are tumour grade and stage. They are correlated, and grade is used for indirect staging. The diagnostic examinations should include multiphase computed tomography urography (CTU) with corticomedullary phase, and urethrocystoscopy with cytology. If there is no clear diagnosis for clinical decision-making, ureterorenoscopy (URS) with focal cytology and biopsies should be performed. Both WHO classification systems (1973/1999 and 2004/2016) should be used. Novel biomarker tests are not yet widespread nor recommended for the detection of UTUC. Long-term, regular follow-up, including URS in patients who have had organ-sparing treatment, is important to check for tumour recurrences, intravesical recurrences, metastases and progression of the tumour. CONCLUSION Proper diagnostics with correct grading of UTUC are necessary for appropriate treatment decisions. The diagnostics should include CTU with corticomedullary phase, urine or bladder cytology, URS with focal barbotage cytology, and biopsies when needed for proper diagnosis and risk stratification. Regular, long-term follow-ups are fundamental, due to the high rate of recurrence and risk of progression.
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Affiliation(s)
- Filip Sydén
- Department of Urology, Stockholm South General Hospital, Stockholm, Sweden
| | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Matthew Bultitude
- Guy's and St. Thomas' NHS Foundation Trust, Urology Centre/Stone Unit, Guy's and St. Thomas' Hospital, London, UK
| | | | - Morgan Rouprêt
- Sorbonne University, Pitié Salpétrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kay Thomas
- Guy's and St. Thomas' NHS Foundation Trust, Urology Centre/Stone Unit, Guy's and St. Thomas' Hospital, London, UK
| | | | - Georg Jaremko
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Helene Jung
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Camilla Malm
- Department of Urology, Stockholm South General Hospital, Stockholm, Sweden
| | | | - Palle Jørn Sloth Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Marianne Brehmer
- Department of Urology, Stockholm South General Hospital, Stockholm, Sweden.
- Department of Clinical Sciences Karolinska Institute, Stockholm, Sweden.
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11
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Kim D, You D, Jeong IG, Hong JH, Ahn H, Hong B. Kidney sparing surgery in upper tract urothelial carcinoma: paradigm change in surgical treatment for ureter cancer. J Cancer Res Clin Oncol 2023; 149:13717-13725. [PMID: 37522922 DOI: 10.1007/s00432-023-05207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To extend the indications of kidney-sparing surgery (KSS) for ureter cancer by comparing the oncological outcomes between patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) or KSS. METHODS We retrospectively reviewed 708 patients with UTUC who underwent RNU (N = 646) or KSS (N = 62) between 2011 and 2019 to analyze the oncologic outcomes and prognostic factors. Subgroup analyses were performed for patients with unifocal ureteral urothelial carcinoma (UC). RESULTS No significant difference was observed in the overall survival (OS) or cancer-specific survival (CSS) between RNU and KSS (distal ureterectomy with reimplantation (N = 33), ureterectomy with ileal ureter (N = 14), ureteroscopic tumor resection (N = 10), and ureterectomy with ureteroureterostomy (N = 5)). Among 269 (38.0%) patients with unifocal ureteral UC, 219 and 50 patients underwent RNU and KSS, respectively. OS and CSS were not significantly different between these two groups. Pathologic stage was a significant risk factor in multivariate analysis (hazard ratio = 2.621; p = 0.000). Among 646 RNU patients, 219 (33.9%) had unifocal ureteral UC, 40 (18.3%) with low-grade tumors. Among these, 13 (5.9%) patients with unifocal, low-grade and small (< 2 cm) tumors received nephroureterectomy. CONCLUSION Kidney-sparing surgery should be regarded as an important alternative to RNU for patients with unifocal ureteral UC thought to have noninvasive disease to preserve renal function and reduce overtreatment.
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Affiliation(s)
- Dongsu Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea.
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12
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Gallioli A, Basile G, Territo A, Verri P, Gaya JM, Sanguedolce F, Aumatell J, Izquierdo P, Uleri A, Diana P, Huguet J, Algaba F, Palou J, Breda A. The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma. World J Urol 2023; 41:2743-2749. [PMID: 37668716 DOI: 10.1007/s00345-023-04577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE The purpose of the study was to evaluate the effect of second-look ureteroscopy (SU) in the endoscopic operative work-up of patients with upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS Patients with UTUC who underwent SU between 2016 and 2021 were included. Cancer detection rate (CDR) at SU was defined as endoscopic visualization of tumor. The effect of SU on recurrence-free survival (RFS), radical nephroureterectomy-free survival (RNU-FS), bladder cancer-free survival (BC-FS), and cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Multivariate logistic regression analysis (MLR) assessed predictors of negative SU. Finally, we evaluated the effect of SU timing on oncological outcomes, classifying SUs as "early" (≤ 8 weeks) and "late" (> 8 weeks). RESULTS Overall, 85 patients underwent SU. The CDR at SU was 44.7%. After a median follow-up was 35 (IQR: 15-56) months, patients with positive SU had a higher rate of UTUC recurrence (47.4% vs 19.1%, p = 0.01) and were more frequently radically treated (34.2% vs 8.5%, p = 0.007). Patients with high-grade disease (hazard ratio [HR]: 3.14, 95% CI 1.18-8.31; p = 0.02) had a higher risk of UTUC recurrence, while high-grade tumor (HR: 3.87, 95%CI 1.08-13.77; p = 0.04) and positive SU (HR: 4.56, 95%CI 1.05-22.81; p = 0.04) were both predictors of RNU. Low-grade tumors [odds ratio (OR): 5.26, 95%CI 1.81-17.07, p = 0.003] and tumor dimension < 20 mm (OR: 5.69, 95%CI 1.48-28.31, p = 0.01) were predictors of negative SU. Finally, no significant difference emerged regarding UTUC recurrence, RNU, BC-FS, and CSM between early vs. late SUs (all p > 0.05). CONCLUSIONS SU may help in identifying patients with UTUC experiencing an early recurrence after conservative treatment. Patients with low-grade and small tumors are those in which SU could be safely postponed after 8 weeks.
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Affiliation(s)
- Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
- Department of Urology, University of Turin, Turin, Italy
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Julia Aumatell
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Paula Izquierdo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
- Department of Urology, Humanitas University, Rozzano, Milan, Italy
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
- Department of Urology, Humanitas University, Rozzano, Milan, Italy
| | - Jorge Huguet
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Ferran Algaba
- Department of Pathology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
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13
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Liu Y, Zhang H, Wen Z, Jiang Y, Huang J, Wang C, Chen C, Wang J, Bao E, Yang X. Simultaneous radical cystectomy and nephroureterectomy in the treatment of panurothelial carcinoma: a systematic review and single-arm meta-analysis. Front Oncol 2023; 13:1233125. [PMID: 37817773 PMCID: PMC10561089 DOI: 10.3389/fonc.2023.1233125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Background Panurothelial carcinoma is a rare and aggressive malignancy that requires effective treatment strategies to enhance patient outcomes. Methods We conducted a systematic search of English publications in databases including PubMed, Embase, Cochrane Library, and Web of Science up to May 2023. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS) and the Methodological Quality and Synthesis of Case Series and Case Reports tool. Data statistics and analysis were performed using Stata 15.1 software (StataSE, USA). Results Six studies involving 339 patients were included in the analysis. Meta-analysis revealed that Simultaneous Radical Cystectomy and Nephroureterectomy had 2-year and 5-year overall survival rates of 68% (95% CI 60%-76%, I2 = 12.4%, P < 0.001) and 44% (95% CI 36%-53%, I2 = 0, P < 0.001), respectively. The 2-year and 5-year progression-free survival rates were 91% (95% CI 86%-95%, I2 = 95%, P < 0.001) and 65% (95% CI 58%-73%, I2 = 91.5%, P < 0.001), respectively. The 2-year and 5-year cancer-specific survival rates were 73% (95% CI 66%-81%, I2 = 16.7%, P < 0.001) and 57% (95% CI 49%-66%, I2 = 0, P < 0.001), respectively. Additionally, the incidence of minor complications was 19% (95% CI 15%-23%, P < 0.01), major complications was 49% (95% CI 34%-63%, P < 0.01), and the intraoperative blood transfusion rate was 53% (95% CI 44%-61%, P < 0.01). Conclusions Simultaneous radical cystectomy and nephroureterectomy represent feasible approaches for the treatment of Panurothelial carcinoma. Nonetheless, a comprehensive assessment of the surgical risks and benefits is imperative, and larger-scale prospective cohort studies are required to validate therapeutic efficacy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023426401.
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Affiliation(s)
- Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Huimin Zhang
- Department of Urology, Chengdu Xinhua Hospital Affiliated to North Sichuan Medical College, Chengdu, China
| | - Zhi Wen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yu Jiang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Huang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chongjian Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Caixia Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jiahao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Erhao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xuesong Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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14
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Tufano A, Perdonà S, Viscuso P, Frisenda M, Canale V, Rossi A, Del Prete P, Passaro F, Calarco A. The Impact of Ethnicity and Age on Distribution of Metastases in Patients with Upper Tract Urothelial Carcinoma: Analysis of SEER Data. Biomedicines 2023; 11:1943. [PMID: 37509582 PMCID: PMC10377577 DOI: 10.3390/biomedicines11071943] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Upper tract urothelial carcinoma (UTUC) constitutes a rare and aggressive entity accounting for 5% to 10% of all urothelial tumors. The importance of stratification and disparities according to ethnicity and age has never been tested in a sufficiently large sample of patients with metastatic UTUC (mUTUC). We conducted this study to address this void, and we hypothesized that the distribution of metastases may vary according to age and ethnicity. Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016), we identified 1115 patients with mUTUC. The chi-square and t-test tests were used to examine statistical significance in terms of proportions and mean differences. A total of 925 (83.0%) patients were Caucasians, while 190 (17.0%) were African Americans. Among both ethnicities, lungs were the most common metastatic site (39.1% vs. 48.9%). Brain metastases were infrequent among both ethnicities (1.2 vs. 2.6%; p = 0.13). The trends in the lung metastases decreased with age from 42.3% to 36.6% (p = 0.010) among Caucasians, whereas they increased among African Americans from 34.0% to 51.7% (p = 0.04). Overall, 32.8% of Caucasians and 40.5% of African Americans exhibited more than one metastatic site. Among Caucasians, increasing age was associated with lower rates of having multiple metastatic sites (from 34.3% to 30.2%) (p = 0.004). According to our multivariable analyses, younger age was associated with an increased risk of lung (OR: 1.29, 95% CI 1.04-1.71; p = 0.045) and bone metastases (OR: 1.34, 95% CI 1.07-1.79; p = 0.046). Racial differences exist in the distribution of mUTUC metastasis and vary according to age. Our findings may also be considered in the design of randomized trials.
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Affiliation(s)
- Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, 00161 Rome, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via M. Semmola, 80131 Naples, Italy
| | - Pietro Viscuso
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, 00161 Rome, Italy
| | - Marco Frisenda
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, 00161 Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, 00161 Rome, Italy
| | | | - Paola Del Prete
- Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via M. Semmola, 80131 Naples, Italy
| | - Francesco Passaro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
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15
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Abdelaziz A, Sultan M, Hammad MA, Martinez JR, Yacoub M, Youssef RF. Endophytic upper tract urothelial carcinoma in a solitary kidney treated by cryotherapy: an unorthodox case for successful management. BMC Urol 2023; 23:111. [PMID: 37370049 DOI: 10.1186/s12894-023-01279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Nephroureterectomy remains the gold standard treatment for upper tract urothelial carcinoma (UTUC). Considering the high risk of developing renal function impairment after surgery, the rationale for nephron sparing approaches in treatment of UTUC has been raised. In this case, renal cryoablation was able to achieve successful oncologic control while preserving renal function during 5 years of follow up without intraoperative or post operative complications. CASE PRESENTATION A 79 year old male presents after three months of macroscopic hematuria. Imaging revealed a 3.6 × 3.1 × 2.7 cm endophytic mass in the interpolar region of the left kidney and an atrophic right kidney. After weighing the lesion's location with the patient's of complex medical history, he was counselled to undergo a minimally invasive percutaneous cryoablation as treatment for his solitary renal mass. A diagnostic dilemma was encountered as imaging suggested a diagnosis of renal cell carcinoma. However, the pre-ablation biopsy established an alternative diagnosis, revealing UTUC. Percutaneous cryoablation became an unorthodox treatment modality for the endophytic component of his UTUC followed by retrograde ureteroscopic laser fulguration. The patient was followed in 3 months, 6 months, then annually with cross sectional imaging by MRI, cystoscopy, urine cytology and renal function testing. After five years of follow-up, the patient did not encountered recurrence of UTUC or deterioration in renal function, thereby maintaining a stable eGFR. CONCLUSION Although evidence for nephron-sparing modalities for UTUC is mounting in recent literature, limited data still exists on cryotherapy as a line of treatment for urothelial carcinoma. We report successful management of a low-grade UTUC using cryoablation with the crucial aid of an initial renal biopsy and long-term follow-up. Our results provide insight into the role of cryoablation as a nephron-sparing approach for UTUC.
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Affiliation(s)
- Ahmad Abdelaziz
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Mark Sultan
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Muhammed A Hammad
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Juan Ramon Martinez
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Maria Yacoub
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Ramy F Youssef
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA.
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16
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Evmorfopoulos K, Mitrakas L, Karathanasis A, Zachos I, Tzortzis V, Vlachostergios PJ. Upper Tract Urothelial Carcinoma: A Rare Malignancy with Distinct Immuno-Genomic Features in the Era of Precision-Based Therapies. Biomedicines 2023; 11:1775. [PMID: 37509415 PMCID: PMC10376290 DOI: 10.3390/biomedicines11071775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Upper tract urothelial carcinoma (UTUC) is a rare malignancy, occurring in 5-10% of patients diagnosed with UC, and involves the renal pelvis, calyces, or ureters. UTUC can be sporadic or hereditary as a clinical manifestation of Lynch syndrome. Therapeutic management of these patients is challenging. Following risk stratification of localized disease, patients with low-grade UTUC may undergo kidney-sparing surgery or radical nephroureterectomy (RNU) and/or chemoablation with mitomycin-c instillation to reduce recurrence. In high-grade disease, RNU followed by adjuvant chemotherapy remains the standard of care. For decades, platinum-based chemotherapy has been the cornerstone of treatment for locally advanced and metastatic disease. The aim of the present review is to summarize recent advances in UTUC's therapeutic management through the lens of its genomic and immune landscape. Accumulating knowledge on the genetic and immune aspects of UTUC tumors has increased our understanding of their underlying biology, supporting a luminal papillary, T-cell depleted contexture and enrichment in fibroblast growth factor receptor (FGFR) expression. These advances have fueled successful clinical testing of several precision-based therapeutic approaches, including immune checkpoint inhibitors (ICIs), the antibody-drug conjugates (ADCs) enfortumab vedotin and sacituzumab govitecan, and agents targeting the FGFR axis such as erdafitinib and other kinase inhibitors, allowing their entry into the therapeutic armamentarium and improving the prognosis of these patients. Not all patients respond to these precision-based targeted therapies; thus, validating and expanding the toolkit of potential biomarkers of response or resistance, including molecular subtypes, FGFR pathway gene alterations, DNA repair gene defects, tumor mutational burden (TMB), circulating tumor DNA (ctDNA), nectin-4, TROP2, and programmed death ligand-1 (PD-L1), are key to maximizing the benefit to these particular subgroups of patients.
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Affiliation(s)
- Konstantinos Evmorfopoulos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Lampros Mitrakas
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Athanasios Karathanasis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Ioannis Zachos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Panagiotis J. Vlachostergios
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
- Department of Medical Oncology, IASO Thessalias Hospital, 41500 Larissa, Greece
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
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17
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Zhu PY, Wang L, Li KP, Yin S, Chen XB. Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes. World J Surg Oncol 2023; 21:163. [PMID: 37248555 DOI: 10.1186/s12957-023-03046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The debate on whether to choose a transperitoneal (TP) or retroperitoneal (RP) approach for treating upper urinary tract urothelial carcinoma (UTUC) with laparoscopic surgery has been drawing attention. This study aimed to systematically review and meta-analyze the existing evidence regarding oncologic and perioperative outcomes of transperitoneal laparoscopic radical nephroureterectomy (TLNU) and retroperitoneal laparoscopic radical nephroureterectomy (RLNU) in managing UTUC. METHODS A comprehensive literature search was conducted using PubMed, Scopus, Embase, and Google Scholar for identifying randomized controlled trials (RCTs) and observational studies that evaluated the outcomes of TLNU and RLNU for UTUC. Continuous variables were represented by weighted mean difference (WMD) and standard mean difference (SMD), while binary variables were represented by odds ratio (OR), with 95% confidence intervals (CIs). The quality was assessed using the Newcastle-Ottawa scale. A sensitivity analysis was performed to evaluate the robustness of the estimates. RESULT Six observational studies were incorporated into this meta-analysis. The overall TLNU was associated with significantly shorter operating time (WMD - 19.85; 95% CI - 38.03 to - 1.68; P = 0.03); longer recovery time of intestinal function (SMD 0.46; 95% CI 0.08 to 0.84; P = 0.02). However, the terms of estimated blood loss (WMD - 5.72; 95% CI - 19.6 to - 8.15; P = 0.42); length of stay (WMD - 0.35; 95% CI - 1.61 to 0.91; P = 0.59), visual analog pain scale (WMD - 0.38; 95% CI - 0.99 to 0.84; P = 0.22); drainage duration (WMD - 0.22; 95% CI - 0.61 to 0.17; P = 0.26); overall complication rates (OR 1.24; 95% CI 0.58 to 2.63; P = 0.58); local recurrence rate (OR 0.6; 95% CI 0.3 to 1.21; P = 0.16); distant metastasis (OR 0.94; 95% CI 0.04 to 20.77; P = 0.97); 1-year overall survival (OS) (OR 0.45; 95% CI 0.1 to 2.01; P = 0.3) showed no difference between TLNU and RLUN. CONCLUSION TLNU provides similar surgical outcomes and oncologic results compared to RLUN; however, TLNU has a shorter procedure time and prolonged intestinal function recovery time. Due to the heterogeneity among the studies, randomized clinical trials with follow-ups in the long term are required to obtain more definite results. TRIAL REGISTRATION www.crd.york.ac.uk/prospero/ , identifier CRD42023388554.
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Affiliation(s)
- Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
| | - Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Kun-Peng Li
- Department of Urology, Affiliated Hospital of Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiao-Bin Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
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18
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Rouprêt M, Seisen T, Birtle AJ, Capoun O, Compérat EM, Dominguez-Escrig JL, Gürses Andersson I, Liedberg F, Mariappan P, Hugh Mostafid A, Pradere B, van Rhijn BWG, Shariat SF, Rai BP, Soria F, Soukup V, Wood RG, Xylinas EN, Masson-Lecomte A, Gontero P. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. Eur Urol 2023; 84:S0302-2838(23)02652-0. [PMID: 36967359 DOI: 10.1016/j.eururo.2023.03.013] [Citation(s) in RCA: 109] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC. OBJECTIVE To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION The recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts. EVIDENCE SYNTHESIS Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1-positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab). CONCLUSIONS These guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours. PATIENT SUMMARY Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist.
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Affiliation(s)
- Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France.
| | - Thomas Seisen
- GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France
| | - Alison J Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; University of Manchester, Manchester, UK
| | - Otakar Capoun
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Pathology, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria
| | - Eva M Compérat
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Pathology, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria; Department of Pathology, Sorbonne University, AP-HP, Hôpital Tenon, Paris
| | | | | | - Fredrik Liedberg
- Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Paramananthan Mariappan
- Department of Urology, Edinburgh Bladder Cancer Surgery, Western General Hospital, Edinburgh, UK
| | - A Hugh Mostafid
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Bas W G van Rhijn
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Shahrokh F Shariat
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Francesco Soria
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Viktor Soukup
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Pathology, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria
| | | | - Evanguelos N Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France
| | | | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
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19
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Coleman JA, Yip W, Wong NC, Sjoberg DD, Bochner BH, Dalbagni G, Donat SM, Herr HW, Cha EK, Donahue TF, Pietzak EJ, Hakimi AA, Kim K, Al-Ahmadie HA, Vargas HA, Alvim RG, Ghafoor S, Benfante NE, Meraney AM, Shichman SJ, Kamradt JM, Nair SG, Baccala AA, Palyca P, Lash BW, Rizvi MA, Swanson SK, Muina AF, Apolo AB, Iyer G, Rosenberg JE, Teo MY, Bajorin DF. Multicenter Phase II Clinical Trial of Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy for Patients With High-Grade Upper Tract Urothelial Carcinoma. J Clin Oncol 2023; 41:1618-1625. [PMID: 36603175 PMCID: PMC10043554 DOI: 10.1200/jco.22.00763] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/02/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) has proven survival benefits for patients with invasive urothelial carcinoma of the bladder, yet its role for upper tract urothelial carcinoma (UTUC) remains undefined. We conducted a multicenter, single-arm, phase II trial of NAC with gemcitabine and split-dose cisplatin (GC) for patients with high-risk UTUC before extirpative surgery to evaluate response, survival, and tolerability. METHODS Eligible patients with defined criteria for high-risk localized UTUC received four cycles of split-dose GC before surgical resection and lymph node dissection. The primary study end point was rate of pathologic response (defined as < ypT2N0). Secondary end points included progression-free survival (PFS), overall survival (OS), and safety and tolerability. RESULTS Among 57 patients evaluated, 36 (63%) demonstrated pathologic response (95% CI, 49 to 76). A complete pathologic response (ypT0N0) was noted in 11 patients (19%). Fifty-one patients (89%) tolerated at least three complete cycles of split-dose GC, 27 patients (47%) tolerated four complete cycles, and all patients proceeded to surgery. With a median follow up of 3.1 years, 2- and 5-year PFS rates were 89% (95% CI, 81 to 98) and 72% (95% CI, 59 to 87), while 2- and 5-year OS rates were 93% (95% CI, 86 to 100) and 79% (95% CI, 67 to 94), respectively. Pathologic complete and partial responses were associated with improved PFS and OS compared with nonresponders (≥ ypT2N any; 2-year PFS 100% and 95% v 76%, P < .001; 2-year OS 100% and 100% v 80%, P < .001). CONCLUSION NAC with split-dose GC for high-risk UTUC is a well-tolerated, effective therapy demonstrating evidence of pathologic response that is associated with favorable survival outcomes. Given that these survival outcomes are superior to historical series, these data support the use of NAC as a standard of care for high-risk UTUC, and split-dose GC is a viable option for NAC.
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Affiliation(s)
| | - Wesley Yip
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Harry W. Herr
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eugene K. Cha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - A. Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kwanghee Kim
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gopa Iyer
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Min Y. Teo
- Memorial Sloan Kettering Cancer Center, New York, NY
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20
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Bellmunt J, Chang J, Pavilack-Kirker M, Cappelleri JC, Costa N, Esterberg E, Kearney M, Hitchens A, Candrilli SD, Ajmera M. Evaluating real-world characteristics of patients with advanced urothelial carcinoma eligible for avelumab maintenance therapy: a multi-country retrospective medical chart review. Clin Genitourin Cancer 2023:S1558-7673(23)00080-0. [PMID: 37149458 DOI: 10.1016/j.clgc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Urothelial carcinoma (UC) is a malignancy of the urothelium that encompasses the renal pelvis, bladder, and urethra. Current treatment guidelines for advanced (ie, locally advanced or metastatic) UC recommend using avelumab maintenance therapy in patients with nonprogressive disease following first-line platinum-based chemotherapy. This study aimed to assess the representativeness of the patient population in the JAVELIN Bladder 100 (JB-100) trial, which examined the efficacy and safety of avelumab first-line maintenance, vs. real-world patients with advanced UC that had not progressed with first-line platinum-based chemotherapy treated between 2015 and 2018 by reviewing demographic and clinical characteristics. PATIENTS AND METHODS A medical chart review (MCR) study collected demographics and treatment characteristics for patients with advanced UC in the United States, the United Kingdom, and France. Data were analyzed descriptively for review with data collected from patients enrolled in JB-100. RESULTS Clinical characteristics were consistent between JB-100 and the MCR. Most patients were male, received 4 to 6 cycles of platinum-based chemotherapy, and had an Eastern Cooperative Oncology Group performance status of 0 or 1. All patients in the MCR had either stable disease or a response with platinum-based chemotherapy (∼75% achieved a complete or partial response). Fewer than half (42.5%) of all patients in the MCR received subsequent therapy. CONCLUSION Patient demographics, clinical characteristics, and treatment patterns from a MCR of patients with advanced UC that had not progressed following first-line platinum-based chemotherapy appeared similar to data from patients enrolled in JB-100. Future studies should examine whether real-world outcomes are consistent with findings from JB-100. CLINICALTRIALS GOV IDENTIFIER NCT02603432.
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21
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Paciotti M, Alkhatib KY, Nguyen DD, Yim K, Lipsitz SR, Mossanen M, Casale P, Pierorazio PM, Kibel AS, Trinh QD, Buffi NM, Lughezzani G, Cole AP. Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy? Cancers (Basel) 2023; 15:cancers15051373. [PMID: 36900166 PMCID: PMC10000204 DOI: 10.3390/cancers15051373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75-0.88; p < 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88; p = 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86; p < 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38; p = 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04; p = 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (p < 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.
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Affiliation(s)
- Marco Paciotti
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Khalid Y. Alkhatib
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Urology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
| | - Kendrick Yim
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
| | - Matthew Mossanen
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | | | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nicoló Maria Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Correspondence: ; Tel.: +39-(028)-224-7356
| | - Alexander P. Cole
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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22
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Herout R, Baunacke M, Flegar L, Borkowetz A, Reicherz A, Koch R, Kraywinkel K, Thomas C, Groeben C, Huber J. Upper tract urothelial carcinoma in Germany: epidemiological data and surgical treatment trends in a total population analysis from 2006 to 2019. World J Urol 2023; 41:127-133. [PMID: 36445373 PMCID: PMC9849285 DOI: 10.1007/s00345-022-04219-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/06/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To report contemporary epidemiological data and treatment trends for upper tract urothelial carcinoma (UTUC) in Germany over a 14-year period. METHODS We analyzed data from the nationwide German hospital billing database and the German cancer registry from 2006 to 2018/2019. The significance of changes over time was evaluated via regression analysis. Survival outcomes were calculated using the Kaplan-Meier method. RESULTS There was a non-significant increase in the age-standardized incidence rate from 2.5/100,000 in 2006 to 2.9/100.000 in 2018. 13% of patients presented with lymph node metastasis and 7.6% of patients presented with distant metastasis at primary diagnosis. The 5-year overall survival was estimated at 45% and the 10-year overall survival at 32%. Endoscopic biopsies of the renal pelvis and ureter as well as ureteroscopies with excision/destruction of UTUC all increased significantly over the study period. The number of radical nephroureterectomies (RNU) for UTUC steadily increased from 1643 cases in 2006 to 2238 cases in 2019 (p < 0.005) with a shift from open surgery towards minimally invasive surgery. Complex reconstructive procedures like ileal ureter replacement or autotransplantation are rarely performed for urothelial carcinoma of the ureter. CONCLUSION Diagnostic and therapeutic procedures for UTUC have increased and minimally invasive nephroureterectomy is the predominant approach concerning radical surgery in 2019.
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Affiliation(s)
- Roman Herout
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
| | - Martin Baunacke
- grid.4488.00000 0001 2111 7257Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Luka Flegar
- grid.10253.350000 0004 1936 9756Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Angelika Borkowetz
- grid.4488.00000 0001 2111 7257Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Alina Reicherz
- grid.459734.80000 0000 9602 8737Department of Urology, Ruhr-University of Bochum, Marien Hospital Herne, Herne, Germany
| | - Rainer Koch
- grid.10253.350000 0004 1936 9756Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Klaus Kraywinkel
- grid.13652.330000 0001 0940 3744National Center for Cancer Registry Data, Robert Koch Institute, Berlin, Germany
| | - Christian Thomas
- grid.4488.00000 0001 2111 7257Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christer Groeben
- grid.10253.350000 0004 1936 9756Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Johannes Huber
- grid.10253.350000 0004 1936 9756Department of Urology, Philipps-University Marburg, Marburg, Germany
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23
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Immunotherapy for Urological Tumors on YouTube TM: An Information-Quality Analysis. Vaccines (Basel) 2022; 11:vaccines11010092. [PMID: 36679937 PMCID: PMC9866846 DOI: 10.3390/vaccines11010092] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND YouTubeTM is an open-access source for mass information. Several previous studies of YouTubeTM videos showed a high rate of misinformation in the urological field. The aim of the current study was to evaluate the quality of information on immunotherapy (IMT) for urological tumors uploaded to YouTubeTM. METHODS YouTubeTM videos were searched using nine keyword combinations. The PEMAT, the DISCERN tool, and the Misinformation scale were used to assess the quality of information in YouTubeTM videos about IMT for urological tumors. Descriptive statistics and Kruskal-Wallis, Chi-square, proportion, and Pearson's tests were performed. RESULTS According to the selection criteria, 156 YouTubeTM videos were suitable for the analysis and stratified according to topic (urothelial carcinoma vs. renal cell cancer vs. prostate cancer vs. general information on IMT). According to PEMAT A/V, the overall Understandability score was 40% (Inter-Quartile Range [IQR]: 20-61.5) and the overall Actionability score was 0% (IQR: 0-25). According to the DISCERN tool, the overall DISCERN score was 44 (IQR: 39-53.2), defined as "fair". According to the Misinformation scale, we recorded the lowest median overall score for item 4 ("IMT in multimodality approach") and item 5 ("Future perspective"). CONCLUSIONS YouTubeTM cannot be recommended as a reliable source of information on IMT for urological malignancies. In addition, YouTubeTM videos contributed to the spread of misinformation by underestimating the role of IMT in a multimodality approach and missing the findings of published clinical trial results.
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Tae JH, Ha MS, Chi BH, Chang IH, Kim TH, Myung SC, Nguyen TT, Kim M, Lee KE, Kim Y, Woo HK, Kyoung DS, Kim H, Choi SY. Neoadjuvant versus adjuvant chemotherapy in upper tract urothelial carcinoma: A nationwide cohort study. BMC Urol 2022; 22:175. [PMID: 36352437 PMCID: PMC9644507 DOI: 10.1186/s12894-022-01112-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose This study aimed to evaluate the trend of adjuvant chemotherapy (AC) and neoadjuvant chemotherapy (NAC) in patients who underwent radical nephroureterectomy with bladder cuff excision (NUx) for upper tract urothelial carcinoma (UTUC) to compare the perioperative outcomes and overall survival (OS) between AC and NAC using nationwide population-based data. Materials and methods We collected data on patients diagnosed with UTUC and treated with NUx between 2004 and 2016 using the National Health Insurance Service database, and evaluated the overall treatment trends. The AC and NAC groups were propensity score-matched. Cox proportional hazard and Kaplan-Meier analyses were used to assess survival. Results Of the 8,705 enrolled patients, 6,627 underwent NUx only, 94 underwent NAC, and 1,984 underwent AC. The rate of NUx without perioperative chemotherapy increased from 70.8 to 78.2% (R2 = 0.632; p < 0.001). The rates of dialysis (p = 0.398), TUR-BT (p = 1.000), and radiotherapy (p = 0.497) after NUx were similar. In the Kaplan-Meier curve, the NAC and AC groups showed no significant difference (p = 0.480). In multivariate analysis, treatment with AC or NAC was not associated with OS (hazard ratio 0.83, 95% confidence interval 0.49–1.40, p = 0.477). Conclusion The use of NUx without perioperative chemotherapy has tended to increase in South Korea. Dialysis, TUR-BT, and radiotherapy rates after NUx were similar between the NAC and AC groups. There was no significant difference in OS between the NAC and AC groups. Proper perioperative chemotherapy according to patient and tumor conditions should be determined by obtaining more evidence of UTUC.
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Huang CC, Liu HY, Hsu TW, Lee WC. Updates on the Pivotal Roles of Mitochondria in Urothelial Carcinoma. Biomedicines 2022; 10:biomedicines10102453. [PMID: 36289714 PMCID: PMC9599371 DOI: 10.3390/biomedicines10102453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Mitochondria are important organelles responsible for energy production, redox homeostasis, oncogenic signaling, cell death, and apoptosis. Deregulated mitochondrial metabolism and biogenesis are often observed during cancer development and progression. Reports have described the crucial roles of mitochondria in urothelial carcinoma (UC), which is a major global health challenge. This review focuses on research advances in the role of mitochondria in UC. Here, we discuss the pathogenic roles of mitochondria in UC and update the mitochondria-targeted therapies. We aim to offer a better understanding of the mitochondria-modulated pathogenesis of UC and hope that this review will allow the development of novel mitochondria-targeted therapies.
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Affiliation(s)
- Chiang-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Hui-Ying Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Tsuen-Wei Hsu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 8306)
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Wu F, Zhang P, Li L, Lin S, Liu J, Sun Y, Wang Y, Luo C, Huang Y, Yan X, Zhang M, Liu G, Li K. Inadvertent radical nephrectomy leads to worse prognosis in renal pelvic urothelial carcinoma patients: A propensity score-matched study. Front Oncol 2022; 12:948223. [PMID: 36249047 PMCID: PMC9561472 DOI: 10.3389/fonc.2022.948223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo compare overall survival (OS) and cancer-specific survival (CSS) in renal pelvic urothelial carcinoma (RPUC) patients treated with radical nephroureterectomy (NU) and inadvertent radical nephrectomy (RN).Patients and methodsIn this retrospective study, patients with RPUC who underwent NU or RN diagnosed between 2004 and 2017 were identified from the Surveillance, Epidemiology, and End Results database. To adjust the confounders, the propensity score-matched analysis was conducted. The Kaplan–Meier method and log-rank test were performed to explore the effect of different surgical methods on OS and CSS.ResultsA total of 2197 cases were finally included in this analysis, among which, 187 (8.5%) patients were treated with RN and 2010 (91.5%) patients were treated with NU. Before matching, the survival analysis revealed that the OS (HR: 1.444, 95%CI: 1.197, 1.741) and CSS (HR: 1.522, 95%CI: 1.211, 1.914) of patients who received RN were worse than that of patients who received NU (p = 0.0001 and p = 0.0003, respectively). After matching, the RN group had a worse OS (HR: 1.298, 95%CI: 1.002, 1.682) than the NU group (p = 0.048). No significant difference was observed in CSS between the RN and NU groups (p = 0.282). The hierarchical analysis showed that there was no significant difference observed in OS and CSS in patients with tumor size ≤4.2 cm (p = 0.884 and p = 0.496, respectively). In tumor size >4.2 cm, both OS (HR: 1.545, 95%CI: 1.225, 1.948) and CSS (HR: 1.607, 95%CI: 1.233, 2.095) of patients who received RN were worse than those of patients who received NU (p = 0.0002 and p = 0.0005).ConclusionRN could lead to worse oncological outcomes than NU in patients with renal pelvis urothelial carcinoma. Accurate diagnosis of renal pelvis urothelial carcinoma is extremely important.
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Chien AL, Chua KJ, Doppalapudi SK, Ghodoussipour S. The role of endoscopic management and adjuvant topical therapy for upper tract urothelial cancer. FRONTIERS IN UROLOGY 2022; 2:916259. [PMID: 38855025 PMCID: PMC11160966 DOI: 10.3389/fruro.2022.916259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Upper tract urothelial carcinoma (UTUC) has traditionally been managed with radical nephroureterectomy, and while this approach remains the gold standard for high-risk disease, endoscopic, kidney-sparing management has increasingly been adopted for low-risk disease as it preserves kidney function without compromising oncologic outcomes. Ureteroscopy and percutaneous renal access not only provide diagnoses by tumor visualization and biopsy, but also enable treatment with electrocautery or laser ablation. Several modalities exist for laser ablative treatments including thulium:YAG, neodymium:YAG, holmium:YAG, and combinations of the preceding. Furthermore, due to high recurrence rates after endoscopic management, adjuvant intracavitary instillation of various agents such as mitomycin C and bacillus Calmette-Guerin have been used given benefits seen in non-muscle invasive urothelial bladder cancer. Other formulations also being studied include gemcitabine, anthracyclines, and immunotherapies. More recently, Jelmyto, a mitomycin reverse thermal gel, has been developed to allow for adequate drug delivery time and potency since urine flow could otherwise dilute and washout topical therapy. In this article, the authors review techniques, indications, best practices, and areas of current investigation in endoscopic management and adjuvant topical therapy for UTUC.
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Affiliation(s)
- Austin L. Chien
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Kevin J. Chua
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Sai Krishnaraya Doppalapudi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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[Correlation between daily fluid intake behavioral habits and pathological characteristics of upper tract urothelial carcinoma]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022. [PMID: 35950383 PMCID: PMC9385528 DOI: 10.19723/j.issn.1671-167x.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the correlation between drinking habits and pathological characteristics of patients with upper tract urothelial carcinoma (UTUC). METHODS A preoperative questionnaire survey was conducted to understand the drinking habits of UTUC patients who were admitted to the Department of Urology, Peking University First Hospital for radical nephroureterectomy within one year from August 2020 to July 2021, and statistical analysis was performed in combination with their postoperative pathological characteristics. The statistical procedure was performed using SPSS 22.0 software, and firstly, the preliminary analysis was performed one by one using the columnar χ2 test on the pathological characteristics of UTUC tumors as the dependent variable and the factors related to patients' general information, past history and drinking habits as the independent variables, and the independent variables that met P < 0.2 between the case and control groups for each dependent variable were specified for screening. The screened variables were included in the binary Logistic regression analysis. A difference of P < 0.05 was used to indicate a statistically significant difference. RESULTS A total of 239 patients, 134 males and 105 females, with a mean age of (68.1±9.98)years and a median disease duration of 4.8 months, were included in this study. Multifactorial Logistic regression results suggested that after adjusting for the effects of other variables, UTUC patients who had the habit of drinking at least once every hour during the daytime had a significantly increased risk of high grade (G3) tumors(OR=1.941, 95%CI: 0.352-1.029, P < 0.01); these patients also had a significantly decreased risk of multifocal UTUC tumors (OR=0.344, 95% CI: 1.18-5.582, P=0.004). The patients who had the habit of drinking over 100 mL water each time had a significantly decreased risk of mutifocal UTUC incidence (OR=0.477, 95%CI: 0.225-1.012, P=0.046). Patients who pay attention to daily water intakes had a significantly increased risk of renipelvic carcinoma (OR=2.530, 95%CI: 1.434-4.463, P=0.001) and a significantly decreased risk of ureteral carcinoma (OR=0.314, 95%CI: 0.172-0.573, P < 0.01). Other variables included in the regression model did not differ significantly in their effects on the occurrence of tumor pathological characteristics. CONCLUSION Having the awareness of drinking water every 1 h during the day, drinking over 100 mL water each time, having the awareness of daily drinking habits correlated significantly with pathological characteristics of UTUC such as the presence of G3 tumor, multifocal tumors and location of the tumor. This conclusion still needs to be verified by subsequent trials with higher levels of evidence.
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Pallauf M, König F, D’Andrea D, Laukhtina E, Mostafaei H, Motlagh RS, Quhal F, Aydh A, Yanagisawa T, Kawada T, Rajwa P, Lusuardi L, Soria F, Karakiewicz PI, Rouprêt M, Rink M, Lotan Y, Margulis V, Singla N, Xylinas E, Shariat SF, Pradere B. A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery. Front Oncol 2022; 12:907975. [PMID: 35847838 PMCID: PMC9283688 DOI: 10.3389/fonc.2022.907975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background Current guidelines recommend assessing the prognosis in high-risk upper tract urothelial carcinoma patients (UTUC) after surgery. However, no specific method is endorsed. Among the various prognostic models, nomograms represent an easy and accurate tool to predict the individual probability for a specific event. Therefore, identifying the best-suited nomogram for each setting seems of great interest to the patient and provider. Objectives To identify, summarize and compare postoperative UTUC nomograms predicting oncologic outcomes. To estimate the overall performance of the nomograms and identify the most reliable predictors. To create a reference tool for postoperative UTUC nomograms, physicians can use in clinical practice. Design A systematic review was conducted following the recommendations of Cochrane’s Prognosis Methods Group. Medline and EMBASE databases were searched for studies published before December 2021. Nomograms were grouped according to outcome measurements, the purpose of use, and inclusion and exclusion criteria. Random-effects meta-analyses were performed to estimate nomogram group performance and predictor reliability. Reference tables summarizing the nomograms’ important characteristics were created. Results The systematic review identified 26 nomograms. Only four were externally validated. Study heterogeneity was significant, and the overall Risk of Bias (RoB) was high. Nomogram groups predicting overall survival (OS), recurrence-free survival (RFS), and intravesical recurrence (IVR) had moderate discrimination accuracy (c-Index summary estimate with 95% confidence interval [95% CI] and prediction interval [PI] > 0.6). Nomogram groups predicting cancer-specific survival (CSS) had good discrimination accuracy (c-Index summary estimate with 95% CI and PI > 0.7). Advanced pathological tumor stage (≥ pT3) was the most reliable predictor of OS. Pathological tumor stage (≥ pT2), age, and lymphovascular invasion (LVI) were the most reliable predictors of CSS. LVI was the most reliable predictor of RFS. Conclusions Despite a moderate to good discrimination accuracy, severe heterogeneity discourages the uninformed use of postoperative prognostic UTUC nomograms. For nomograms to become of value in a generalizable population, future research must invest in external validation and assessment of clinical utility. Meanwhile, this systematic review serves as a reference tool for physicians choosing nomograms based on individual needs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282596, identifier PROSPERO [CRD42021282596].
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Affiliation(s)
- Maximilian Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - David D’Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Abdulmajeed Aydh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Faisal Medical City, Abha, Saudi Arabia
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Morgan Rouprêt
- Department of Urology, Pitié Salpétrière Hospital, Oncotype-Uro, Sorbonne University, Paris, France
| | - Michael Rink
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, United States
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern, Dallas, TX, United States
| | - Nirmish Singla
- Departments of Urology and Oncology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, University of Texas Southwestern, Dallas, TX, United States
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia
- Department of Urology, Weill Cornell Medical College, New York, NY, United States
- Karl Landsteiner Insitute of Urology and Andrology, Karl Landsteiner Society, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
- *Correspondence: Benjamin Pradere,
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Martini A, Lonati C, Nocera L, Fallara G, Raggi D, Herout R, Zamboni S, Ploussard G, Predere B, Mattei A, Simeone C, Krajewski W, Simone G, Soria F, Gontero P, Roupret M, Montorsi F, Briganti A, Shariat SF, Necchi A, Moschini M. Oncologic Surveillance After Radical Nephroureterectomy for High-risk Upper Tract Urothelial Carcinoma. Eur Urol Oncol 2022; 5:451-459. [DOI: 10.1016/j.euo.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/20/2022] [Accepted: 04/06/2022] [Indexed: 11/04/2022]
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Peyrottes A, Califano G, Ouzaïd I, Lainé-Caroff P, Long Depaquit T, Hermieu JF, Xylinas E. Lymph Node Dissection During Radical Nephro-Ureterectomy for Upper Tract Urothelial Carcinoma: A Review. Front Surg 2022; 9:852969. [PMID: 35402485 PMCID: PMC8987284 DOI: 10.3389/fsurg.2022.852969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023] Open
Abstract
Although lymphonodal dissection is well-accepted for muscle-invasive bladder cancer management, its role is still debated during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The aim of this study was to summarize the current knowledge concerning the indication, anatomical template, prognostic, and therapeutic roles of lymph node dissection (LND) performed at the time of RNU. Quality control markers, such as the number of lymph nodes (LN) removed, lymph node density, and safety of the different surgical approaches, were assessed. We performed a narrative review using the PubMed and ClinicalTrials.gov databases. We identified and analyzed articles based on the practice and the role of lymph node dissection for non-metastatic UTUC. There are no clear guidelines regarding the indication of LND for UTUC, but aggressive tumors may beneficiate from lymphadenectomy since lymph node invasion is a clear independent poor prognostic factor, allowing for adjuvant treatments. It seems that an extended lymphadenectomy may provide therapeutic advantages as a higher number of nodes removed may be related to the removal of undetected LNs micrometastases and a subsequent improvement in recurrence rate and cancer-specific survival. Clear anatomical templates are thus needed based on the location and the laterality of the primary tumor.
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Affiliation(s)
- Arthur Peyrottes
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Gianluigi Califano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Idir Ouzaïd
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Paul Lainé-Caroff
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Thibaut Long Depaquit
- Urology Unit, Military Teaching Hospital Sainte Anne, French Military Health Service, Toulon, France
| | - Jean-François Hermieu
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
- *Correspondence: Evanguelos Xylinas
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Califano G, Ouzaid I, Laine-Caroff P, Peyrottes A, Collà Ruvolo C, Pradère B, Elalouf V, Misrai V, Hermieu JF, Shariat SF, Xylinas E. Current Advances in Immune Checkpoint Inhibition and Clinical Genomics in Upper Tract Urothelial Carcinoma: State of the Art. Curr Oncol 2022; 29:687-697. [PMID: 35200559 PMCID: PMC8870958 DOI: 10.3390/curroncol29020060] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023] Open
Abstract
Upper tract urothelial carcinoma (UTUC) is a rare and challenging-to-treat malignancy. In most patients it is a sporadic tumor entity, less commonly it falls on the spectrum of Lynch syndrome, an autosomal dominant familial tumor syndrome. Localized UTUC with high-risk features as well as the metastatic disease scenario might require systemic therapy. Platinum-based combination chemotherapy is currently the recommended management option. However, the introduction of immune checkpoint inhibitors into the therapeutic armamentarium has led to a paradigm shift in treatment standards. Immunotherapy has been shown to be safe and effective in treating at least metastatic UTUC, although UTUC-specific high-level evidence is still lacking. Recent technological advances and noteworthy research efforts have greatly improved the general understanding of the biological landscape of UTUC. According to the main findings, UTUC represent a particular subtype of urothelial carcinoma frequently associated with activated FGFR3 signaling, a luminal–papillary phenotype and a T-cell-depleted microenvironment. This improved knowledge promises precision oncology approaches that match treatment decision strategies and genomic profile to ultimately result in better clinical outcomes. The aim of this review was to summarize the main currently available evidence on immune checkpoint inhibition and clinical genomics in UTUC.
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Affiliation(s)
- Gianluigi Califano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (C.C.R.)
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, 75018 Paris, France; (I.O.); (P.L.-C.); (A.P.); (J.-F.H.)
| | - Idir Ouzaid
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, 75018 Paris, France; (I.O.); (P.L.-C.); (A.P.); (J.-F.H.)
| | - Paul Laine-Caroff
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, 75018 Paris, France; (I.O.); (P.L.-C.); (A.P.); (J.-F.H.)
| | - Arthur Peyrottes
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, 75018 Paris, France; (I.O.); (P.L.-C.); (A.P.); (J.-F.H.)
| | - Claudia Collà Ruvolo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (C.C.R.)
| | - Benjamin Pradère
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria; (B.P.); (S.F.S.)
| | - Vincent Elalouf
- Department of Urology, Hospital Claude Galien, 91480 Quincy-sous-Sénart, France;
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, UMR-1048 Toulouse, France;
| | - Jean-François Hermieu
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, 75018 Paris, France; (I.O.); (P.L.-C.); (A.P.); (J.-F.H.)
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria; (B.P.); (S.F.S.)
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, 75018 Paris, France; (I.O.); (P.L.-C.); (A.P.); (J.-F.H.)
- University of Paris, INSERM, Immunologie Humaine Physiopathologie & Immunothérapie, F-75010 Paris, France
- Correspondence: ; Tel.: +33-140-257-102
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Deloumeaux J, Bhakkan-Mambir B, Desroziers L, Plenet J, Peruvien J, Chatignoux É, Belliardo S, Macni J, Ulric-Gervaise S, Véronique-Baudin J, Joachim C. Urological Cancers in French Overseas Territories: A Population-Based Cancer Registry Pooled Analysis in Martinique, Guadeloupe and French Guiana (2007-2014). J Epidemiol Glob Health 2022; 12:232-238. [PMID: 35041179 PMCID: PMC9470795 DOI: 10.1007/s44197-022-00033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Prostate cancer is the most common cancer in the Caribbean. We present world-standardized incidence (WSI) and mortality (WSM) rates for urological cancers for French overseas territories. Materials and Methods Standardized incidence ratio (SIR) and standardized mortality ratio (SMR) were calculated for 2008–2014, 2007–2014 and 2010–2014 in Guadeloupe, Martinique and French Guiana. Results For prostate cancer, in Guadeloupe and Martinique, the WSI rates are among the highest in the world (173.0 and 164.5 per 100,000 person-years) and 94.4 in French Guiana. Mortality remains more than twice that observed in mainland France, at 23.0 in Guadeloupe and Martinique, and 16.9 in French Guiana. For bladder cancer, WSI rates were 5.9, 4.9 and 4.1 in men, and 1.9, 1.4 and 1.3 in women, in French Guiana, Guadeloupe and Martinique. WSM rates from bladder varied from 1.5 in French Guiana to 1.8 in Guadeloupe and 2.0 in Martinique in men. In women, it ranges from 0.2 in French Guiana to 0.5 in Guadeloupe and 1.1 in Martinique. Regarding kidney, WSI rates in men are 4.3 in Martinique, 5.2 in Guadeloupe and 6.1 in French Guiana, and 2.3, 2.5 and 3.4, respectively, in women. Mortality rates in men were 1.7 in Guadeloupe, 1.4 in Martinique, and 1.5 in French Guiana, while in women, rates were 0.8 in Guadeloupe and Martinique and 0.6 in French Guiana. All these rates are lower than in mainland France. Conclusions Identifying the profile of patients with urological cancers is key to understanding the needs of patients in these regions.
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Affiliation(s)
- Jacqueline Deloumeaux
- Registre Général des Cancers de Guadeloupe, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe F.W. I., Route de Chauvel, 97159 Pointe-à-Pitre Cedex, France
| | - Bernard Bhakkan-Mambir
- Registre Général des Cancers de Guadeloupe, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe F.W. I., Route de Chauvel, 97159 Pointe-à-Pitre Cedex, France
| | | | | | - Jessica Peruvien
- Registre Général des Cancers de Guadeloupe, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe F.W. I., Route de Chauvel, 97159 Pointe-à-Pitre Cedex, France
| | - Édouard Chatignoux
- French National Public Health Agency, 12 rue du Val d’Osne, 94410 Saint Maurice, France
| | | | - Jonathan Macni
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, UF 1441 Registre Général des Cancers de la Martinique, Fort de France, 97200 Martinique
| | - Stephen Ulric-Gervaise
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, UF 1441 Registre Général des Cancers de la Martinique, Fort de France, 97200 Martinique
| | - Jacqueline Véronique-Baudin
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, UF 1441 Registre Général des Cancers de la Martinique, Fort de France, 97200 Martinique
| | - Clarisse Joachim
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, UF 1441 Registre Général des Cancers de la Martinique, Fort de France, 97200 Martinique
- Hôpital Albert Clarac, Avenue Pasteur, CS 90632, 97200 Fort de France, Martinique
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Fero KE, Shan Y, Lec PM, Sharma V, Srinivasan A, Movva G, Baillargeon J, Chamie K, Williams SB. Treatment Patterns, Outcomes, and Costs Associated With Localized Upper Tract Urothelial Carcinoma. JNCI Cancer Spectr 2021; 5:pkab085. [PMID: 34805743 PMCID: PMC8599752 DOI: 10.1093/jncics/pkab085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/28/2021] [Accepted: 08/27/2021] [Indexed: 11/14/2022] Open
Abstract
Background Upper tract urothelial carcinoma (UTUC) is a heterogeneous disease that presents a clinical management challenge for the urologic surgeon. We assessed treatment patterns, costs, and survival outcomes among patients with nonmetastatic UTUC. Methods We identified 4114 patients diagnosed with nonmetastatic UTUC from 2004 to 2013 in the Survival Epidemiology, and End Results-Medicare population-based database. Patients were stratified into low- or high-risk disease groups. Median total costs from 30 days prior to diagnosis through 365 days after diagnosis were compared between groups. Overall and cancer-specific survival were evaluated using Cox proportional hazards regression. All statistical tests were 2-sided. Results After risk stratification, 1027 (24.9%) and 3087 (75.0%) patients were classified into low- vs high-risk UTUC groups. Most patients underwent at least 1 surgical intervention (95.1%); 68.4% underwent at least 1 endoscopic intervention. Patients diagnosed with high- vs low-risk UTUC were more likely to undergo nephroureterectomy (83.6% vs 72.0%; P < .001); few patients with low-risk disease were exclusively managed endoscopically (16.9%). At 365 days after diagnosis, costs of care for high- vs low-risk UTUC were statistically significantly higher ($108 520 vs $91 233; median difference $16 704, 95% confidence interval [CI] = $11 619 to $21 778; P < .001). Those with high-risk UTUC had worse cancer-specific and overall survival compared with patients with low-risk UTUC (cancer-specific survival hazard ratio [HR] = 4.14, 95% CI = 3.19 to 5.37; overall survival HR = 1.78, 95% CI = 1.62 to 1.96). Conclusions UTUC continues to be managed primarily with nephroureterectomy, regardless of risk stratification, and patients with high-risk UTUC have worse overall and cancer-specific survival. Substantial costs are associated with management of low- and high-risk UTUC, with the latter being more costly up to 1 year from diagnosis.
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Affiliation(s)
- Katherine E Fero
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Yong Shan
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Patrick M Lec
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Vidit Sharma
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Aditya Srinivasan
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Giri Movva
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jacques Baillargeon
- Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
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Collà Ruvolo C, Würnschimmel C, Nocera L, Wenzel M, Tian Z, Shariat SF, Saad F, Verze P, Imbimbo C, Briganti A, Mirone V, Karakiewicz PI. Stage and cancer-specific mortality differ within specific Asian ethnic groups for upper tract urothelial carcinoma: North American population-based study. Int J Urol 2021; 28:1247-1252. [PMID: 34480378 DOI: 10.1111/iju.14682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/09/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine the effect of specific Asian ethnic subgroups on stage at presentation and cancer-specific mortality in non-metastatic upper tract urothelial carcinoma among North American upper tract urothelial carcinoma Asian patients treated with radical nephroureterectomy. METHODS We relied on the Surveillance, Epidemiology and End Results database, from 2004 to 2016. Kaplan-Meier plots and multivariable Cox regression models predicting cancer-specific mortality were used. RESULTS Of 584 upper tract urothelial carcinoma patients, 173 (29.6%) were Chinese versus 130 (22.3%) Japanese versus 68 (11.6%) Korean versus 64 (11.0%) Filipino versus 40 (6.8%) Vietnamese versus 109 (18.7%) other. Vietnamese and Chinese patients showed the highest rates of T4 N0 M0 and/or T1-4 N1-2 M0 (25.0% and 18.5%, respectively), relative to other Asian ethnic subgroups. In Kaplan-Meier plots, Vietnamese patients showed the highest cancer-specific mortality rate. In multivariable models, Vietnamese ethnicity also independently predicted higher cancer-specific mortality (hazard ratio 2.15, P = 0.02 and hazard ratio 1.96, P = 0.03), relative to Japanese and Chinese patients. All other Asian ethnic subgroups showed similar cancer-specific mortality patterns. CONCLUSION Vietnamese and Chinese patients are at a stage disadvantage at upper tract urothelial carcinoma diagnosis, relative to all other Asian ethnicities. After adjustment for stage, only Vietnamese patients showed a survival disadvantage relative to all other Asian ethnic subgroups. As a result, it appears that Vietnamese patients not only present at a higher upper tract urothelial carcinoma stage, but additionally appear to harbor upper tract urothelial carcinoma that progresses at a faster rate than in other Asian ethnic subgroups.
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Affiliation(s)
- Claudia Collà Ruvolo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Quebec, Canada.,Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, Italy
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Quebec, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Quebec, Canada.,Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Mike Wenzel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Quebec, Canada.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Quebec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York City, New York, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Quebec, Canada
| | - Paolo Verze
- Urology Unit, Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Quebec, Canada
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The effect of race on stage at presentation and survival in upper tract urothelial carcinoma. Urol Oncol 2021; 39:788.e7-788.e13. [PMID: 34330651 DOI: 10.1016/j.urolonc.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/16/2021] [Accepted: 07/01/2021] [Indexed: 12/21/2022]
Abstract
Background The effect of racial/ethnic group on survival in upper tract urothelial carcinoma (UTUC) is unknown. We tested this concept in non-metastatic UTUC patients treated with radical nephroureterectomy (RNU) and hypothesized that important differences may exist according to racial/ethnic groups. Material and Methods We relied on the Surveillance Epidemiology and End Results database (2004-2016). We relied on Propensity-score matching (ratio 1:4). Subsequently, cumulative incidence plots and multivariable competing risks regression models (CRR) addressed cancer-specific mortality (CSM). Results Of 9129 assessable patients, 7454 (81.7%) were Caucasian vs. 665 (7.3%) Hispanic vs. 584 (6.4%) Asian vs. 426 (4.7%) African-American. No statistically significant differences were recorded for tumor grade or T-stage, between all racial/ethnic groups. However, within patents who received lymph-node dissection (n = 2694, 29.5%), Asians exhibited the highest rate of more than 2 positive lymph nodes at RNU (19.0%, followed by 17.1% African-Americans, 15.0% Caucasians and 12.6% Hispanics, P < 0.001). After PS-matching and multivariable CRR, Asian race/ethnicity independently predicted higher CSM, relative to Caucasians (Hazard ratio: 1.29, P < 0.01). No statistically significant differences according to CSM was recorded in the remaining races/ethnicities comparisons (all P ≥ 0.1) Conclusion Important CSM differences may exist according to race/ethnicity in non-metastatic UTUC patients treated with RNU. However, these differences only apply to Asian patients, who account for 6% of the overall non-metastatic UTUC cohort treated with RNU. In consequence, in clinical practice Asian patients should be given particular attention with the intent of reducing the CSM disadvantage that cannot be clearly explained by stage and/or grade disadvantage at diagnosis.
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Collà Ruvolo C, Würnschimmel C, Wenzel M, Nocera L, Celentano G, Mangiapia F, Tian Z, Shariat SF, Saad F, Chun FHC, Briganti A, Longo N, Mirone V, Karakiewicz PI. Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy. Int J Clin Oncol 2021; 26:1707-1713. [PMID: 34091795 PMCID: PMC8364897 DOI: 10.1007/s10147-021-01941-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022]
Abstract
Aims The European Association of Urology guideline for upper tract urothelial carcinoma (UTUC) relies on two grading system: 1973 World Health Organization (WHO) and 2004/2016 WHO. No consensus has been made which classification should supersede the other and both are recommended in clinical practice. We hypothesized that one may be superior to the other. Methods Newly diagnosed non-metastatic UTUC patients treated with radical nephroureterectomy were abstracted from the Surveillance, Epidemiology, and End Results database (2010–2016). Kaplan–Meier plots and multivariable Cox regression models (CRMs) tested cancer-specific mortality (CSM), according to 1973 WHO (G1 vs. G2 vs. G3) or to 2004/2016 WHO (low-grade vs. high-grade) grading systems. Haegerty’s C-index quantified accuracy. Results Of 4271 patients, according to 1973 WHO grading system, 134 (3.1%) were G1, 436 (10.2%) were G2 and 3701 (86.7%) were G3; while according to 2004/2016 WHO grading system, 508 (11.9%) were low grade vs 3763 (88.1%) high grade. In multivariable CRMs, high grade predicted higher CSM (Hazard ratio: 1.70, p < 0.001). Conversely, neither G2 (p = 0.8) nor G3 (p = 0.1) were independent predictors of worse survival. The multivariable models without consideration of either grading system were 74% accurate in predicting 5-year CSM. Accuracy increased to 76% after either addition of the 1973 WHO or 2004/2016 WHO grade. Conclusions From a statistical standpoint, either 1973 WHO or 2004/2016 WHO grading system improves the accuracy of CSM prediction to the same extent. In consequence, other considerations such as intra- and interobserver variability may represent additional metrics to consider in deciding which grading system is better. Supplementary Information The online version contains supplementary material available at 10.1007/s10147-021-01941-9.
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Affiliation(s)
- Claudia Collà Ruvolo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada. .,Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada.,Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mike Wenzel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada.,Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Celentano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesco Mangiapia
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Departments of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada
| | - Felix H C Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Vincenzo Mirone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada
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Contemporary analysis of the effect of marital status on survival in upper tract urothelial carcinoma patients treated with radical nephroureterectomy: A population-based study. Urol Oncol 2021; 39:789.e9-789.e17. [PMID: 34092481 DOI: 10.1016/j.urolonc.2021.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Unmarried status is an established risk factor for worse cancer control outcomes in various malignancies. Moreover, several investigators observed worse outcomes in unmarried males, but not in females. This concept has not been tested in upper tract urothelial carcinoma and represents the topic of the study. METHODS Within Surveillance, Epidemiology and End Results database (2004-2016), we identified 8833 non-metastatic upper tract urothelial carcinoma patients treated with radical nephroureterectomy (5208 males vs. 3625 females). Kaplan Meier plots and multivariable Cox regression models predicting overall mortality, other-cause mortality and cancer-specific mortality were used. RESULTS Overall, 1323 males (25.4%) and 1986 females (54.8%) were unmarried. Except for lower rates of chemotherapy in unmarried males (15.6 vs. 19.6%, P = 0.001) and unmarried females (13.8 vs. 23.6%, P < 0.001), no clinically meaningful differences were recorded between males and females. In multivariable Cox regression models, unmarried status was an independent predictor of higher overall mortality in both males (Hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 1.19-1.48, P < 0.001) and females (HR: 1.13, 95%CI: 1.00-1.27, P = 0.04), as well as of higher other-cause mortality in both males (HR: 1.53, 95%CI: 1.26-1.84,P < 0.001) and females (HR: 1.43, 95%CI: 1.15-1.78,P < 0.01). However, higher cancer-specific mortality was only recorded in unmarried males (HR: 1.24, 95%CI: 1.08-1.42, P < 0.01), but not in females (HR: 1.02, 95%CI: 0.89-1.17, P = 0.7). CONCLUSION Unmarried status is a marker of worse survival in both males and females and should be flagged as an important risk factor at diagnosis, in both sexes. In consequence, unmarried patients represent candidate for interventions aimed at decreasing the survival gap relative to married counterparts.
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van Doeveren T, van der Mark M, van Leeuwen PJ, Boormans JL, Aben KKH. Rising incidence rates and unaltered survival rates for primary upper urinary tract urothelial carcinoma: a Dutch population-based study from 1993 to 2017. BJU Int 2021; 128:343-351. [PMID: 33690922 PMCID: PMC8453942 DOI: 10.1111/bju.15389] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Aim To assess trends in the incidence, disease management and survival rates for upper urinary tract urothelial carcinoma (UTUC) in the Netherlands. Materials and methods Patients diagnosed with primary UTUC in the Netherlands between 1993 and 2017 were identified through the population‐based Netherlands Cancer Registry (NCR). Patient and tumour characteristics, as well as information on treatment and vital status, were retrieved from the NCR. Age‐standardized incidence rates were calculated, stratified by age, gender, calendar period and disease stage. Relative survival served as an approximation for cancer‐specific survival. Results We identified 13 314 patients with primary UTUC. The age‐standardized incidence rate increased from 2.0 in 1993 to 3.2 per 100 000 person‐years in 2017, without change in gender distribution. The increase in incidence held for all disease stages except organ‐confined (T1–T2) disease. The most prominent increase was in superficial (Tis/Ta) and metastatic (M+) UTUC, which increased from 0.6 to 1.2 and 0.1 to 0.4 per 100 000 person‐years, respectively. The 5‐year relative survival did not change over time: 57.0% (95% confidence interval 55.9–58.1). Applied treatments were largely the same over the study period, although fewer radical nephroureterectomies and more kidney‐sparing surgeries were performed in the most recent years. The use of peri‐operative intravesical chemotherapy modestly increased. Conclusion Between 1993 and 2017, the age‐standardized incidence of primary UTUC in the Netherlands has increased by more than 50%, but the relative survival of UTUC patients remained unchanged. Preventive measures against exposure to risk factors, early detection of disease, and more efficacious treatment methods are needed to improve outcomes of patients with UTUC.
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Affiliation(s)
- Thomas van Doeveren
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marianne van der Mark
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Piszczek R, Nowak Ł, Krajewski W, Chorbińska J, Poletajew S, Moschini M, Kaliszewski K, Zdrojowy R. Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis. World J Surg Oncol 2021; 19:129. [PMID: 33882936 PMCID: PMC8061074 DOI: 10.1186/s12957-021-02236-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/07/2021] [Indexed: 01/02/2023] Open
Abstract
Background During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU. Materials and methods The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled. Results Eighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60–1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62–1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85–1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94–1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter. Conclusions Our present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02236-z.
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Affiliation(s)
- Radosław Piszczek
- Department of Urology and Oncologic Urology, Lower Silesian Specialist Hospital, Fieldorfa 2 Street, 50-556, Wroclaw, Poland
| | - Łukasz Nowak
- Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland.
| | - Wojciech Krajewski
- Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland
| | - Joanna Chorbińska
- Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland
| | - Sławomir Poletajew
- Centre of Postgraduate Medical Education, Marymonecka 99/813 Street, 01-813, Warsaw, Poland
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse, 6004, 16, Lucerne, Switzerland
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland
| | - Romuald Zdrojowy
- Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland
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Tumor Size Predicts Muscle-invasive and Non-organ-confined Disease in Upper Tract Urothelial Carcinoma at Radical Nephroureterectomy. Eur Urol Focus 2021; 8:498-505. [PMID: 33737024 DOI: 10.1016/j.euf.2021.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pathological stage and grade of renal pelvis urothelial carcinoma (RPUC) are difficult to estimate before radical nephroureterectomy (RNU). OBJECTIVE To examine tumor size as an independent predictor of muscle-invasive and/or non-organ-confined rates of RPUC at RNU. DESIGN, SETTING, AND PARTICIPANTS Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2016), we identified nonmetastatic RPUC at RNU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS First, we examined stage and grade distributions. Second, two separate univariable and subsequent multivariable logistic regression models (LRMs) were fitted to test the association between tumor size and the rate of (1) muscle-invasive or higher (pT2-4N0-2) and (2) non-organ-confined (pT3-4N0-2) RPUC at RNU. RESULTS AND LIMITATIONS Of 4657 patients, 3052 (65.5%) had pT2-4N0-2 and 2382 (51.2%) pT3-4N0-2 RPUC at RNU. The median tumor size was 3.7 cm (interquartile range 2.5-5.0). The high-grade RPUC rate ranged from 71.1% to 87.2% (p < 0.001) among SEER registries. Conversely, no differences were recorded for stage (p > 0.05) or tumor size (p = 0.1) across all registries. Rates of pT2-4N0-2 and pT3-4N0-2 RPUC increased with tumor size. Specifically, for tumor size intervals from 0.1-1.0 cm to 9.1-10.0 cm, the pT2-4N0-2 rate ranged from 45% to 83% and the pT3-4N0-2 rate ranged from 23% to 75%, respectively (both p < 0.001). In multivariable LRMs, tumor size (in 1-cm units) was an independent predictor of pT2-4N0-2 (odds ratio [OR] 1.25; p < 0.001) and pT3-4N0-2 (OR 1.30; p < 0.001) disease at RNU. CONCLUSIONS Tumor size is a key predictor of muscle-invasive or non-organ-confined RPUC. Greater tumor size directly and virtually linearly predicts a higher rate of invasive or non-organ-confined RPUC at RNU. PATIENT SUMMARY For patients with cancer in urinary tract cells lining the kidney, larger tumor size predicts worse stage of the disease at surgery.
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